Low Prevalence of Hip and Knee Arthritis in Active Marathon Runners

Does Running Increase the Risk of Hip and Knee Arthritis? A Survey of 3804 Marathon Runners

BACKGROUND

Long-distance running is a popular form of cardiovascular exercise with many well-described health benefits, from improving heart health to the management of obesity, diabetes, and mental illness. The impact of long-distance running on joint health in recreational runners, however, remains inconclusive.

HYPOTHESIS

The prevalence of osteoarthritis in runners is not associated with an athlete's running-related history, including the number of marathons completed, cumulative years of running, average weekly mileage, and average running pace.

STUDY DESIGN

Prospective cohort study.

LEVEL OF EVIDENCE

Level 3.

METHODS

A survey was distributed to all participants registered for the 2019 or 2021 Chicago marathon (n = 37,917). Surveys collected runner demographics and assessed for hip/knee pain, osteoarthritis, family history, surgical history, and running-related history. Running history included the number of marathons run, number of years running, average running pace, and average weekly mileage. The overall prevalence of osteoarthritis was identified, and a multivariable logistic regression model was used to identify variables associated with the presence of hip and/or knee osteoarthritis.

RESULTS

Surveys were completed by 3804 participants (response rate of 10.0%). The mean age was 43.9 years (range, 18-83 years) and participants had completed on average 9.5 marathons (median, 5 marathons; range, 1-664 marathons). The prevalence of hip and/or knee arthritis was 7.3%. A history of hip/knee injuries or surgery, advancing age, family history, and body mass index (BMI) were risk factors for arthritis. Cumulative number of years running, number of marathons completed, weekly mileage, and mean running pace were not significant predictors for arthritis. The majority (94.2%) of runners planned to run another marathon, despite 24.2% of all participants being told by a physician to do otherwise.

CONCLUSION

From this largest surveyed group of marathon runners, the most significant risk factors for developing hip or knee arthritis were age, BMI, previous injury or surgery, and family history. There was no identified association between cumulative running history and the risk for arthritis.

Enlarged colony housing promotes linear progression of subchondral bone remodeling in joint instability rat models

Objective: Osteoarthritis (OA) is a disease with high prevalence and an unmet medical need for disease modifying treatments. In rat models, OA-like subchondral bone and cartilage changes can be induced by instability surgery with different severity levels. Factors which determine structural changes additionally comprise the study duration and activity-impacted joint loading. Methods: A medial meniscal tear (MMT) or anterior cruciate ligament transection with partial meniscectomy (ACLT+pMx) was induced unilaterally in rats housed in a rat colony cage (RCC), allowing high activity levels including jumping and stair climbing. In parallel, ACLT+pMx rats were housed in Type IV cages. The time course of OA-related changes was investigated at 4, 8, 12, and 16 weeks after surgery by micro-CT, gait analysis and joint diameter measurements. Results: Gait disturbance was observed after 2 weeks and to a similar extend in all models. The increase in ipsilateral joint diameters peaked after 2 weeks and were more pronounced after ACLT+pMx compared to MMT-surgery, but independent of housing. Micro-CT analysis revealed that increases in osseous tibial width were most distinct after ACLT+pMx in RCC and progressed continuously until week sixteen. In contrast, osseous tibial width of ipsilateral joints in MMT RCC and ACLT+pMx Type IV groups did not increase further after week twelve. In contralateral joints, this parameter was not affected, regardless of the model or caging. However, a significant increase in bone volume fraction and trabecular thickness was observed over time in the femur and tibia of both ipsilateral and contralateral knees. Here, the medial tibial compartment of the operated joint was most affected and linear changes were most pronounced in the ACLT+pMx RCC group. Conclusion: Increased movement of animals in colony cages leads to robust structural changes in subchondral bone after surgically induced joint instability over time, while in regular Type IV housing maximal changes are reached in week twelve. The new insights into the differentiation of the models, particularly with respect to the linear progression of bone changes in ACLT+pMx in the RCC, may be useful for the design of chronic OA-studies within a longer lifespan and therefore supporting the development of novel therapies.

A Pilot Study: Do Children Who Run Marathons Have More Osteoarthritis in the Lower Extremities as Adults

OBJECTIVE

To compare self-reported osteoarthritis of the knee and hip in adults who ran at least 1 marathon as a child with adults who ran high-school cross country (HSCC).

DESIGN

Subject self-recall retrospective survey.

SETTING

Electronic survey.

PARTICIPANTS

319 adults who either ran a marathon under age 18 or ran HSCC recruited from running clubs, marathon participants, and on-line interest groups.

INTERVENTIONS

Survey.

MAIN OUTCOME MEASURES

Self-reported history of osteoarthritis (OA), joint pain, anterior cruciate ligament injury, still running or running marathons, and number of marathons as an adult.

RESULTS

One hundred twenty-three respondents ran a marathon under age 18 (26% female) and were 40 years old (sd 16) and 196 ran HSCC (53% female) and were 36 years old (sd 13). The mean age of first marathon was 15 (sd 2.3, range 5-17); 50% ran 1% and 50% ran >1 marathon. Child marathoners reported a family history of OA in knees or hips (26%) or a joint replacement (30%) compared with 24% and 28% of HSCC runners. 10% of child marathoners and 7% of HSCC reported OA and 24% and 21% reported daily or weekly joint pain. 91% of all respondents are still running; 78% of child marathoners (mean 17, range 1-91) and 80% HSCC ran ≥1 marathons as adults (mean 10, range 1-80).

CONCLUSIONS

Adults who ran marathons as children compared with adults who ran HSCC self-report similar rates of the knee and hip OA, chose to participate of their own accord, continue to run as adults, played other sports, and did not "specialize" in marathons.

The association between running volume and knee osteoarthritis prevalence: A systematic review and meta-analysis

There is conflicting evidence regarding whether regular running is associated with knee osteoarthritis prevalence. Previous evidence reports lower knee osteoarthritis prevalence in recreational runners compared with professionals (with a higher training volume) and controls (who have a lower training volume). The aim of this systematic review and meta-analysis was to determine if weekly running volume is associated with knee osteoarthritis prevalence. Four databases (PubMed, Web of Science, Scopus and SPORTDiscus) were searched from earliest record to November 2021. Included studies must i) recruit participants who ran regularly and recorded weekly running volume; ii) include a control group (running <8 km per week); iii) record knee osteoarthritis prevalence (either by radiological imaging or self-reported diagnosis from a doctor or physiotherapist). Study bias was assessed using the Newcastle-Ottawa Scale (NOS). Pooled effects were estimated using a random effects model. Odds ratios with 95% prediction and confidence intervals are reported. Nine observational case control studies with a total of 12,273 participants (1272 runners) were included in the meta-analysis. Most of the included studies were rated as having a very high (n = 2) or high (n = 3) risk of bias on the Newcastle Ottawa Scale. There was no difference in knee osteoarthritis prevalence between runners and controls (OR = 0.97, 95% CI = 0.56 to 1.68). Runners undertaking 8-32.1 km (OR = 1.17, 95% CI = 0.77 to 1.80), 32.2-48 km (OR = 1.04, 95% CI = 0.48 to 2.31) or > 48 km per week (OR = 0.62, 95% CI = 0.35 to 1.10) did not exhibit higher knee osteoarthritis prevalence compared with controls. It is unclear whether running volume is associated with increased knee osteoarthritis prevalence, future large-scale, high quality prospective studies are required.

Periodical assessment of four horns of knee meniscus using MR T2 mapping imaging in volunteers before and after amateur marathons

To observe the changes and recovery of T2 values of menisci in amateur marathon participants at different times, and to examine the effect of marathon exercise on meniscal microstructure. Twelve healthy marathon volunteers were recruited continuously, including 5 males and 7 females, with mean (± SD) age of 27.5 ± 5.2 years. The body mass indices (BMIs) ranged from 17.6 to 27.2 kg/m², with a mean of 21.9 ± 2.5 kg/m². The 24 knee joints were scanned using a 3 T MR scanner at 1 week before the event, and at 12 h and 2 months after the event. T2 values of the anterior horn of the medial meniscus (MMAH), posterior horn of the medial meniscus (MMPH), anterior horn of the lateral meniscus (LMAH), and posterior horn of the lateral meniscus (LMPH) were measured by drawing the regions of interest (ROIs) on the T2 map images. Wilcoxon sign rank test was used to compare the T2 values between 1 week before and 12 h after the event, and between 1 week before and 2 months after the event in each anatomical region, respectively. The T2 values of the menisci at 12 h after the event were significantly higher (P < 0.05) than those at 1 week before the event. No statistically significant differences in the T2 values of the menisci were found between 2 months after and 1 week before the event (P > 0.05). The T2 values of MMAH, MMPH, LMAH, and LMPH showed a trend of "increasing first and then decreasing" over time, suggesting that the T2 values may reflect meniscal microstructure in amateur marathon runner.

Magnetic Resonance Imaging of the Hips of Runners Before and After Their First Marathon Run: Effect of Training for and Completing a Marathon

Background

No studies have focused on magnetic resonance imaging (MRI) of the hips of marathoners, despite the popularity and injury risks of marathon running.

Purpose

To understand the effect of preparing for and completing a marathon run (42 km) on runners' hip joints by comparing MRI findings before and after their first marathon.

Study Design

Case-control study; Level of evidence, 3.

Methods

A total of 28 healthy adults (14 males, 14 females; mean age, 32.4 years) were recruited after registering for their first marathon. They underwent 3-T MRI of both hips at 16 weeks before (time point 1) and 2 weeks after the marathon (time point 2). After the first MRI, 21 runners completed the standardized, 4 month--long training program and the marathon; 7 runners did not complete the training or the marathon. Specialist musculoskeletal radiologists reported and graded the hip joint structures using validated scoring systems. Participants completed the Hip disability and Osteoarthritis Outcome Score (HOOS) at both imaging time points.

Results

At time point 1, MRI abnormalities of the hip joint were seen in 90% of participants and were located in at least 1 of these areas: labrum (29%), articular cartilage (7%), subchondral bone marrow (14%), tendons (17%), ligaments (14%), and muscles (31% had moderate muscle atrophy). At time point 2, only 2 of the 42 hips showed new findings: a small area of mild bone marrow edema appearance (nonweightbearing area of the hip and not attributable to running). There was no significant difference in HOOS between the 2 time points. Only 1 participant did not finish the training because of hip symptoms and thus did not run the marathon; however, symptoms resolved before the MRI at time point 2. Six other participants discontinued their training because of non-hip related issues: a knee injury, skin disease, a family bereavement, Achilles tendon injury, illness unrelated to training, and a foot injury unrelated to training.

Conclusion

Runners who completed a 4-month beginner training program before their first marathon run, plus the race itself, showed no hip damage on 3-T MRI scans.

A half marathon shifts the mediolateral force distribution at the tibiofemoral joint

Runners' gait patterns vary during a half marathon and influence the knee joint mechanics. Joint contact force is a better estimate of the net joint loadings than external joint moments and closely correlates to injury risks. This study explored the changes of lower limb joint kinematics, muscle activities, and knee joint loading in runners across the running mileages of a half marathon. Fourteen runners completed a half marathon on an instrumented treadmill where motion capture was conducted every 2 km (from 2 to 20 km). A musculoskeletal model incorporating medial/lateral tibiofemoral compartments was used to process the movement data and report outcome variables at the selected distance checkpoints. Statistics showed no changes in joint angles, muscle co-contraction index, ground reaction force variables, and medial tibiofemoral contact force (p > 0.05). Knee adduction moment at 18 km was significantly lower than those at 2 km (p = 0.002, γ = 0.813) and 6 km (p = 0.001, γ = 0.663). Compared to that at 2 km, lateral tibiofemoral contact force was reduced at 18 km (p = 0.030, Hedges' g = 0.690), 16 km (p < 0.001, Hedges' g = 0.782), 14 km (p = 0.045, Hedges' g = 0.859), and 10 km (p < 0.001, Hedges' g = 0.771) respectively. Mechanical realignment of the lower limb may be the cause of the altered knee loadings and possibly led to reduced running economy in response to a prolonged run. The injury potential of the redistributed tibiofemoral forces warranted further studies.

High Boron Silicon Nanotubes Combined with Tai Chi Exercise Rehabilitation Therapy in the Treatment of Knee Arthritis Patients

Tai Chi exercise is gentle, convenient, and easy to learn. It is more economical than traditional medical treatments, and it is regarded as the first choice for rehabilitation therapy by patients with knee arthritis. This article aims to study Tai Chi exercise rehabilitation therapy combined with high boron silicon nanotubes to treat knee arthritis patients. This article mainly introduces the treatment of knee arthritis patients with Tai Chi, which is reflected in the improvement of patients’ walking ability and stability, and explores a three-dimensional motion model to provide better help for patients with knee joints. The article uses data mining methods to collect data on the gene expression of human knee joints and analyzes the causes of knee arthritis caused by its internal structure. The experimental results of this paper show that, under Taijiquan exercise rehabilitation treatment, the time needed by knee arthritis patients to get up and run is reduced by 14%, the standing time of one leg is significantly improved, the fall rate is reduced by 13%, and the body’s static balance ability is improved.

Validity of Recreational Marathon Runners' Self-Reported Anthropometric Data

While studies on large samples of recreational runners have often relied on participants' self-reported height and body mass, the validity of these data have not been investigated for this population. Hence, this study sought to examine the validity of self-reported anthropometric measures among recreational marathon runners. Female (n = 32) and male (n = 135) recreational marathon runners were requested to estimate their body mass and height (and we calculated their self-reported body mass index [BMI]), after which we took actual measures of their body mass and height and calculated their actual BMI. Participants' self-reported values underestimated their actual body mass by 0.65 kg (p < .001, η² = 0.222) and their actual BMI by 0.35 kg ⋅ m^-2 (p < .001, η² = 0.245). There was a significant Assessment Method × Sex Interaction for both body mass (p = .019, η² = 0.033) and BMI (p = .017, η² = 0.034), as women underestimated body mass values more than men. Participants overestimated their height by 0.44 cm (p < .001, η² = 0.075), but the interaction of sex and assessment method for height was not statistically significant. Underestimates of body mass correlated with marathon racing speed (r = .24, p = .006) and body fat percentage (r = -.29, p = .001) in men, but not in women (p > .05). The disagreement between self-reported and measured anthropometric data in the present sample was lower than has been previously reported for the general population, suggesting that marathon runners may more accurately self-perceive and/or report their anthropometric characteristics. These findings are of practical value for health professionals and researchers (e.g., nutritionists and exercise physiologists) questionnaires to recreational marathon runners.

Delayed ACL Reconstruction in Patients ≥40 Years of Age Is Associated With Increased Risk of Medial Meniscal Injury at 1 Year

BACKGROUND

Anterior cruciate ligament (ACL) tears in the pediatric and young adult ACL-deficient knee are often associated with meniscal or chondral injury with delayed time to surgery. The incidence of ACL reconstruction performed in patients aged ≥40 years is rising, and it is unclear if delayed surgery in this cohort similarly affects the health of the meniscus and cartilage.

PURPOSE

To evaluate whether delayed reconstruction in a cohort of patients aged ≥40 years is associated with an increased risk of meniscal or chondral injury.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Records of patients aged ≥40 years who underwent primary arthroscopic ACL reconstruction between 2012 and 2016 at an academic hospital were retrospectively reviewed. Patient characteristic data and time to surgery were recorded. Operative reports were analyzed for meniscal and chondral injuries as well as treatment. Patients were grouped according to time to surgery, defined as early (<90 days) or delayed (≥90 days). Logistic regression modeling was used to form associations between elapsed time to surgery and patient characteristics to meniscal and chondral damage. Additionally, risks for meniscal and chondral injury were analyzed at time points of 180 days and 1 year from injury to surgery.

RESULTS

A total of 227 patients met the study criteria: 106 patients underwent early surgery, and 121 underwent delayed surgery. The authors identified 127 medial meniscal tears and 106 lateral meniscal tears. Medial, lateral, and patellofemoral compartment chondral injury was reported in 127, 82, and 130 patients, respectively. Delayed surgery (≥90 days) was not associated with increased risk of medial or lateral meniscal tears or any chondral injury at 90 days. Each year of increased age was associated with an increased odds ratio: 1.09 ( P = .001) for medial meniscal tears, 1.06 ( P = .014) for lateral meniscal tears, 1.10 ( P = .001) for medial compartment chondral injuries, and 1.07 ( P = .007) for patellofemoral compartment chondral injuries. Additionally, each unit of increased body mass index was associated with an increased odds ratio: 1.09 ( P = .039) for medial meniscal tears and 1.14 ( P = .003) for medial compartment cartilage injury. Analysis of 180-day and 1-year time points revealed an increased risk (odds ratio, 3.47; 95% CI, 1.55-7.77; P = .002) for medial meniscal injury when surgery was delayed for >1 year.

CONCLUSION

Delayed ACL reconstruction (≥90 days) among patients aged ≥40 years was not associated with an increased risk of meniscal or chondral injury. Increasing age and body mass index were associated with higher risks of meniscal and chondral injuries in this cohort. Delay in surgery for >1 year was associated with increased risk of medial meniscal tear.

The Physiology and Biomechanics of the Master Runner

The Master runner (age 35 y and above) represents a unique athletic patient. Lifelong participation in endurance running slows the inevitable age-related decline in aerobic function and muscular strength. Still, the Master runner does not escape the inevitable effects of aging. Master runners experience a steady decline in running performance, that is, typical and maximal running speeds, after the age of 50 years of age. Age-related declines in running performance are driven by a host of factors, including declining cardiovascular function, reduced muscular capacity, altered biomechanics, and greater susceptibility to running-related injury. This review discusses age-related changes in physiology, biomechanics, and running injury susceptibility and practical strategies to maximize running participation in the Master runner.

What are the perceptions about running and knee joint health among the public and healthcare practitioners in Canada?

Objectives

To evaluate the perceptions of the general public and healthcare practitioners (HCP) in Canada about the relationship between running and knee joint health, and to explore HCP`s usual recommendations to runners with knee osteoarthritis (KOA).

Methods

Non-runners and runners (with and without KOA) and HCP completed an online survey regarding the safety of running for knee joint health. HCP also provided information related to usual clinical recommendations. Proportions of agreement were compared between non-runners and runners.

Results

A total of 114 non-runners, 388 runners and 329 HCP completed the survey. Overall, running was perceived as detrimental for the knee joint by 13.1% of the general public, while 25.9% were uncertain. More uncertainty was reported regarding frequent (33.9%) and long-distance (43.6%) running. Statistical analyses revealed greater proportions of non-runners perceiving running negatively compared with runners. Overall, 48.4% believed that running in the presence of KOA would lead to disease progression, while 53.1% believed running would lead to premature arthroplasty. In HCP, 8.2%, 9.1% and 22.2% perceived that running in general, running frequently, or running long-distances are risk factors for KOA, respectively. 37.1% and 2.7% of HCP typically recommended patients with KOA to modify their running training or to quit running, respectively.

Conclusion

High rates of uncertainty among the general public and HCP in Canada outline the need for further studies about running and knee joint health. Filling knowledge gaps will help inform knowledge translation strategies to better orientate the general public and HCP about the safety of running for knee joint health.